NTDs: The London Declaration, one year on

This time last year, a group of politicians, charities and pharmaceutical companies came to London to sign a pledge. They committed to either bring under control or eliminate ten diseases by 2020; ten diseases that currently cause enormous suffering and hardship across the developing world. The diseases in question are among the collection of infections gathered under the umbrella term of ‘neglected tropical diseases’ (NTDs), so it would seem imperative not to neglect the progress that has been made in tackling them in the past 12 months.

The group of organisations that came together last January, and the World Health Organization (WHO), whose roadmap of disease elimination targets they are committed to achieving, have each reported on their progress this month. Uniting to combat NTDs celebrate the provision of 1.12 billion treatments from the pharmaceutical industry to countries with endemic NTDs in 2012 – they report that every request for drugs needed to conduct mass drug administration programmes was met. This included 29 new countries receiving drugs free of charge to treat soil-transmitted helminth infections, raising the number of treatments from 46 million in 2011 to 238 million in 2012 (an increase of over 400 per cent).

It seems pretty clear that the supply of drugs will not be the rate-determining step when it comes to tackling those NTDs for which we have treatments. But at the same time that the supply of free or very low cost treatments enables mass drug administration programmes to expand, they must also be continually assessed with respect to the effect they are having on the ground. In her foreword to the WHO report, Margaret Chan, director-general of the WHO, says: “As more programmes approach their milestones and targets, new tools and protocols are needed to assess the intensity of transmission, support decision-making about when mass drug administration can be stopped, and then to verify interruption of transmission.”

Of course, what ultimately matters is how much closer we are to controlling the transmission of NTDs. Good news from the first year after the London Declaration is that Oman has become the first country to go from endemic trachoma to elimination. Hopefully more countries will follow and we will reach the WHO target of global elimination of trachoma by 2020.

More than drugs

No one is claiming that mass drug administration is the cure-all for NTDs. Eradicating dracunculiasis (guinea worm disease) doesn’t need more drugs, for example, but for people to not have to drink infected water. Only four countries still have endemic dracunculiasis – Ethiopia, Mali, Chad and South Sudan – and the goal for eradication is 2015. That seems possible although, as with polio, another disease close to eradication, getting over the finishing line seems to become harder the closer you get to it.

“Although drugs are critical tools, they are not enough to achieve all the 2020 NTD targets.”

Uniting to combat NTDs (2013)

At the other end of the NTDs spectrum are diseases like dengue, for which there is still no effective control strategy available, be it a drug or a policy. Research is vital to understanding better how the dengue virus spreads and how it causes disease so that we can develop tools to tackle it – some new tools are making good progress but we will likely need a number of viable options.

Then there are the diseases where the available tools are better than nothing but could really do with improving. This forms part of the combined effort to combat NTDs, though, with Uniting to combat NTDs reporting news of a public-private partnership to develop praziquantel, the drug used to treat schistosomiasis, to be more suitable for children. And two NTD diagnostic tests were approved by the regulators in 2012, one for human African trypanosomiasis (sleeping sickness), the other for lymphatic filariasis (elephantiasis). Accurate, efficient and cost-effective tests are crucial to tracking and controlling these diseases.

Looking ahead

It is great that the first year after the London Declaration has delivered so much – though there are a few patches of yellow (delayed progress) among the mostly green (target achieved) scorecard published by Uniting to combat NTDs. The real tests will come in 2015 and 2020, however, as the WHO’s deadlines for elimination and eradication arrive. Will we have seen the end of dracunculiasis and yaws in eight years’ time? Global elimination of trachoma, leprosy, human African trypanosomiasis and lymphatic filariasis? Elimination of five more NTDs across South-east Asia, Africa and the Americas?

Achieving these goals is not as simple as providing existing drug treatments to anyone who needs them. It requires rigorous monitoring, creative innovation to generate additional tools for treatment, vaccination and vector control, and ongoing research to further increase our understanding of these diseases and the interactions between them and us so that we can find and exploit more weaknesses in their defences.

NTDs will not have disappeared by 2020, but we can hope that they will be much less of a burden on us and that we will have demonstrated our ability to remove more of these threats to our health.

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